Addressing acceptance of spectacles amongst children

A key issue for children who have been prescribed spectacles is that they do not always wear them. This means that children do not benefit when they have the potential to. Studies across all resource settings show that spectacle wear is often less than 50%.
Reasons children do not wear prescribed spectacles include:

They are bullied or teased for wearing spectacles

Parents disapprove of the child wearing spectacles

Parents are concerned that spectacles will weaken their child’s eyes

Parents do not buy the spectacles

Teachers do not encourage children to wear their spectacles

The child does not like the spectacles or they are uncomfortable

The child does not perceive any benefit from the spectacles

There are practical ways to help children accept and wear prescribed spectacles

Reasons 1–5 can be addressed through health education for teachers, parents and all children, whether they need spectacles or not.

Reason 6 can be addressed by ensuring that children select the frames they prefer from a range of colours and designs which school children in the programme area say they like, and by checking that the frames are a good fit.

Reason 7 relates to prescribing.

A recent randomised clinical trial compared rates of spectacle wear in children based on the spectacles prescribed. In the trial, children received spectacles only if doing so improved their visual acuity by two or more lines. When followed up 3 to 4 months later, 75% of the children were still wearing their spectacles or had them at school. This is much higher than found in other studies conducted among children of similar ages where spectacles were prescribed based solely on the degree of refractive error found. This meant that spectacles were prescribed even when a child still had good visual acuity in one eye. These children would not notice an improvement in their vision and would be less likely to wear their spectacles.

Prescribing guidance

The following guidelines are based on those followed in the recent randomised clinical trial and should help to avoid unnecessary prescribing of spectacles - which will not be worn - in settings with limited resources. Remember that this approach must not override the needs of each individual child.

Note: These guidelines apply to children with Visual Acuity (VA) < 6/9.

Correction for myopia is indicated if: Minus powered lenses improve the VA by 2 or more logMAR (or Snellen) VA lines in the better eye, or with both eyes tested together.

Correction for hypermetropia is indicated if:

Plus powered lenses improve the acuity by 2 or more logMAR (or Snellen) VA lines in the better eye or with both eyes tested together, and/or noticeably improve eye comfort when reading.

There is amblyopia and the child’s age (ideally under 6 years) suggests that the amblyopia is potentially treatable. Amblyopia is a disorder where the visual centre is not fully developed in the brain. It sometimes known as ‘lazy eye.’

There is esotropia or a large esophoria (squint/strabismus) and the child has some potential for normal binocular vision.

Correction of astigmatism is indicated if:

Cylindrical lenses improve the acuity by 2 or more logMAR (or Snellen) VA lines in the better eye or with both eyes tested together; and/or noticeably improve eye comfort.

There is amblyopia and the child’s age suggests that the amblyopia is potentially treatable.

Correction for anisometropia is indicated if: There is significant anisometropia, i.e. 1 dioptre (1D) or more, and one or more of the following apply:

Correctly balanced lenses improve the acuity of the most affected eye by 2 or more logMAR VA lines

Eye comfort is notably improved.

There is amblyopia and the child’s age suggests that the amblyopia is potentially treatable.

In conclusion

There is increasing evidence that, if most children see better with spectacles than without, a higher proportion will wear them. Ideally, a sample of children who do not wear their spectacles should be interviewed to find out why they are not wearing them and corrective measures can then be put in place. An important measure of success for any school eye health programme is the proportion of children given spectacles who subsequently wear them – it is not enough just to measure and report the number of spectacles that are dispensed.